Evaluation of the dyspeptic patient

A cost-utility study

Mark H. Ebell, Lawrence Warbasse, Christine Brenner

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

BACKGROUND. Traditionally, patients presenting with uncomplicated dyspepsia have been managed using empiric antisecretory therapy, followed by endoscopy in the event of persistent symptoms or complication. Since Helicobacter pylori is now accepted as an important and potentially reversible cause of ulcer disease, it is important to reevaluate the management of dyspepsia. The goal of this study is to evaluate seven outpatient strategies for the management of dyspeptic patients using a cost- utility analysis. METHODS. The study design was that of a cost-utility analysis. The model assumes that an adult patient with signs of dyspepsia but no signs of complication presents to the outpatient office of a primary care physician. Seven strategies are modeled: empiric antisecretory therapy; empiric H pylon eradication using oral omeprazole (500 mg twice daily), clarithromycin (500 mg twice daily), and amoxicillin (1000 mg twice daily); use of either upper endoscopy, an upper gastrointestinal barium study (an upper GI), or the serum titer for H pylori as a diagnostic test to identify patients for H pylori eradication; or use of an initial diagnostic test followed by the serum titer for H pylori. The primary outcome was the cost per quality-adjusted life year (QALY) for each strategy for a 1-year period from presentation; secondary outcomes included the probability of symptomatic ulcer recurrence, cost per ulcer cure, and mortality. RESULTS. Three strategies were similarly cost-effective: empiric H pylori eradication ($1198 per QALY), use of a serum H pylori titer as an initial diagnostic test ($1214 per QALY), and empiric antisecretory therapy ($1288 per QALY). Empiric antisecretory therapy, however, was associated with significantly more symptomatic ulcer recurrences and deaths than any other strategy. CONCLUSIONS. This cost-utility analysis suggests that two strategies are reasonable for patients presenting with dyspepsia: (1) empiric H pylon eradication and (2) use of a serum H pylori titer to identify patients who might benefit from H pylori eradication. The latter strategy may be preferable because it is less likely to lead to antibiotic resistance. Strategies utilizing an upper GI or upper endoscopy (either with or without serum H pylori titer) or empiric antisecretory therapy do not improve outcomes and are associated with greater cost, morbidity, and/or mortality.

Original languageEnglish (US)
Pages (from-to)545-555
Number of pages11
JournalJournal of Family Practice
Volume44
Issue number6
StatePublished - Jun 1 1997
Externally publishedYes

Fingerprint

Pylorus
Costs and Cost Analysis
Quality-Adjusted Life Years
Dyspepsia
Ulcer
Routine Diagnostic Tests
Cost-Benefit Analysis
Serum
Barium
Endoscopy
Outpatients
Therapeutics
Recurrence
Gastrointestinal Endoscopy
Clarithromycin
Omeprazole
Mortality
Amoxicillin
Primary Care Physicians
Microbial Drug Resistance

Keywords

  • Amoxicillin
  • Clarithromycin
  • Cost-benefit analysis
  • Dyspepsia
  • Endoscopy
  • Helicobacter pylori
  • Omeprazole
  • Peptic ulcer
  • Quality of life

ASJC Scopus subject areas

  • Family Practice

Cite this

Ebell, M. H., Warbasse, L., & Brenner, C. (1997). Evaluation of the dyspeptic patient: A cost-utility study. Journal of Family Practice, 44(6), 545-555.

Evaluation of the dyspeptic patient : A cost-utility study. / Ebell, Mark H.; Warbasse, Lawrence; Brenner, Christine.

In: Journal of Family Practice, Vol. 44, No. 6, 01.06.1997, p. 545-555.

Research output: Contribution to journalArticle

Ebell, MH, Warbasse, L & Brenner, C 1997, 'Evaluation of the dyspeptic patient: A cost-utility study', Journal of Family Practice, vol. 44, no. 6, pp. 545-555.
Ebell MH, Warbasse L, Brenner C. Evaluation of the dyspeptic patient: A cost-utility study. Journal of Family Practice. 1997 Jun 1;44(6):545-555.
Ebell, Mark H. ; Warbasse, Lawrence ; Brenner, Christine. / Evaluation of the dyspeptic patient : A cost-utility study. In: Journal of Family Practice. 1997 ; Vol. 44, No. 6. pp. 545-555.
@article{b87cc966db774d949f4fa8bb60dc450d,
title = "Evaluation of the dyspeptic patient: A cost-utility study",
abstract = "BACKGROUND. Traditionally, patients presenting with uncomplicated dyspepsia have been managed using empiric antisecretory therapy, followed by endoscopy in the event of persistent symptoms or complication. Since Helicobacter pylori is now accepted as an important and potentially reversible cause of ulcer disease, it is important to reevaluate the management of dyspepsia. The goal of this study is to evaluate seven outpatient strategies for the management of dyspeptic patients using a cost- utility analysis. METHODS. The study design was that of a cost-utility analysis. The model assumes that an adult patient with signs of dyspepsia but no signs of complication presents to the outpatient office of a primary care physician. Seven strategies are modeled: empiric antisecretory therapy; empiric H pylon eradication using oral omeprazole (500 mg twice daily), clarithromycin (500 mg twice daily), and amoxicillin (1000 mg twice daily); use of either upper endoscopy, an upper gastrointestinal barium study (an upper GI), or the serum titer for H pylori as a diagnostic test to identify patients for H pylori eradication; or use of an initial diagnostic test followed by the serum titer for H pylori. The primary outcome was the cost per quality-adjusted life year (QALY) for each strategy for a 1-year period from presentation; secondary outcomes included the probability of symptomatic ulcer recurrence, cost per ulcer cure, and mortality. RESULTS. Three strategies were similarly cost-effective: empiric H pylori eradication ($1198 per QALY), use of a serum H pylori titer as an initial diagnostic test ($1214 per QALY), and empiric antisecretory therapy ($1288 per QALY). Empiric antisecretory therapy, however, was associated with significantly more symptomatic ulcer recurrences and deaths than any other strategy. CONCLUSIONS. This cost-utility analysis suggests that two strategies are reasonable for patients presenting with dyspepsia: (1) empiric H pylon eradication and (2) use of a serum H pylori titer to identify patients who might benefit from H pylori eradication. The latter strategy may be preferable because it is less likely to lead to antibiotic resistance. Strategies utilizing an upper GI or upper endoscopy (either with or without serum H pylori titer) or empiric antisecretory therapy do not improve outcomes and are associated with greater cost, morbidity, and/or mortality.",
keywords = "Amoxicillin, Clarithromycin, Cost-benefit analysis, Dyspepsia, Endoscopy, Helicobacter pylori, Omeprazole, Peptic ulcer, Quality of life",
author = "Ebell, {Mark H.} and Lawrence Warbasse and Christine Brenner",
year = "1997",
month = "6",
day = "1",
language = "English (US)",
volume = "44",
pages = "545--555",
journal = "Journal of Family Practice",
issn = "0094-3509",
publisher = "Appleton-Century-Crofts",
number = "6",

}

TY - JOUR

T1 - Evaluation of the dyspeptic patient

T2 - A cost-utility study

AU - Ebell, Mark H.

AU - Warbasse, Lawrence

AU - Brenner, Christine

PY - 1997/6/1

Y1 - 1997/6/1

N2 - BACKGROUND. Traditionally, patients presenting with uncomplicated dyspepsia have been managed using empiric antisecretory therapy, followed by endoscopy in the event of persistent symptoms or complication. Since Helicobacter pylori is now accepted as an important and potentially reversible cause of ulcer disease, it is important to reevaluate the management of dyspepsia. The goal of this study is to evaluate seven outpatient strategies for the management of dyspeptic patients using a cost- utility analysis. METHODS. The study design was that of a cost-utility analysis. The model assumes that an adult patient with signs of dyspepsia but no signs of complication presents to the outpatient office of a primary care physician. Seven strategies are modeled: empiric antisecretory therapy; empiric H pylon eradication using oral omeprazole (500 mg twice daily), clarithromycin (500 mg twice daily), and amoxicillin (1000 mg twice daily); use of either upper endoscopy, an upper gastrointestinal barium study (an upper GI), or the serum titer for H pylori as a diagnostic test to identify patients for H pylori eradication; or use of an initial diagnostic test followed by the serum titer for H pylori. The primary outcome was the cost per quality-adjusted life year (QALY) for each strategy for a 1-year period from presentation; secondary outcomes included the probability of symptomatic ulcer recurrence, cost per ulcer cure, and mortality. RESULTS. Three strategies were similarly cost-effective: empiric H pylori eradication ($1198 per QALY), use of a serum H pylori titer as an initial diagnostic test ($1214 per QALY), and empiric antisecretory therapy ($1288 per QALY). Empiric antisecretory therapy, however, was associated with significantly more symptomatic ulcer recurrences and deaths than any other strategy. CONCLUSIONS. This cost-utility analysis suggests that two strategies are reasonable for patients presenting with dyspepsia: (1) empiric H pylon eradication and (2) use of a serum H pylori titer to identify patients who might benefit from H pylori eradication. The latter strategy may be preferable because it is less likely to lead to antibiotic resistance. Strategies utilizing an upper GI or upper endoscopy (either with or without serum H pylori titer) or empiric antisecretory therapy do not improve outcomes and are associated with greater cost, morbidity, and/or mortality.

AB - BACKGROUND. Traditionally, patients presenting with uncomplicated dyspepsia have been managed using empiric antisecretory therapy, followed by endoscopy in the event of persistent symptoms or complication. Since Helicobacter pylori is now accepted as an important and potentially reversible cause of ulcer disease, it is important to reevaluate the management of dyspepsia. The goal of this study is to evaluate seven outpatient strategies for the management of dyspeptic patients using a cost- utility analysis. METHODS. The study design was that of a cost-utility analysis. The model assumes that an adult patient with signs of dyspepsia but no signs of complication presents to the outpatient office of a primary care physician. Seven strategies are modeled: empiric antisecretory therapy; empiric H pylon eradication using oral omeprazole (500 mg twice daily), clarithromycin (500 mg twice daily), and amoxicillin (1000 mg twice daily); use of either upper endoscopy, an upper gastrointestinal barium study (an upper GI), or the serum titer for H pylori as a diagnostic test to identify patients for H pylori eradication; or use of an initial diagnostic test followed by the serum titer for H pylori. The primary outcome was the cost per quality-adjusted life year (QALY) for each strategy for a 1-year period from presentation; secondary outcomes included the probability of symptomatic ulcer recurrence, cost per ulcer cure, and mortality. RESULTS. Three strategies were similarly cost-effective: empiric H pylori eradication ($1198 per QALY), use of a serum H pylori titer as an initial diagnostic test ($1214 per QALY), and empiric antisecretory therapy ($1288 per QALY). Empiric antisecretory therapy, however, was associated with significantly more symptomatic ulcer recurrences and deaths than any other strategy. CONCLUSIONS. This cost-utility analysis suggests that two strategies are reasonable for patients presenting with dyspepsia: (1) empiric H pylon eradication and (2) use of a serum H pylori titer to identify patients who might benefit from H pylori eradication. The latter strategy may be preferable because it is less likely to lead to antibiotic resistance. Strategies utilizing an upper GI or upper endoscopy (either with or without serum H pylori titer) or empiric antisecretory therapy do not improve outcomes and are associated with greater cost, morbidity, and/or mortality.

KW - Amoxicillin

KW - Clarithromycin

KW - Cost-benefit analysis

KW - Dyspepsia

KW - Endoscopy

KW - Helicobacter pylori

KW - Omeprazole

KW - Peptic ulcer

KW - Quality of life

UR - http://www.scopus.com/inward/record.url?scp=0031006248&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031006248&partnerID=8YFLogxK

M3 - Article

VL - 44

SP - 545

EP - 555

JO - Journal of Family Practice

JF - Journal of Family Practice

SN - 0094-3509

IS - 6

ER -